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Showing 1 - 200 of 3043 Journals sorted alphabetically
AASRI Procedia     Open Access   (Followers: 15)
Academic Pediatrics     Hybrid Journal   (Followers: 22, SJR: 1.402, h-index: 51)
Academic Radiology     Hybrid Journal   (Followers: 21, SJR: 1.008, h-index: 75)
Accident Analysis & Prevention     Partially Free   (Followers: 84, SJR: 1.109, h-index: 94)
Accounting Forum     Hybrid Journal   (Followers: 25, SJR: 0.612, h-index: 27)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 30, SJR: 2.515, h-index: 90)
Achievements in the Life Sciences     Open Access   (Followers: 4)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 5, SJR: 0.338, h-index: 19)
Acta Astronautica     Hybrid Journal   (Followers: 350, SJR: 0.726, h-index: 43)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 3)
Acta Biomaterialia     Hybrid Journal   (Followers: 25, SJR: 2.02, h-index: 104)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 1)
Acta de Investigación Psicológica     Open Access   (Followers: 2)
Acta Ecologica Sinica     Open Access   (Followers: 8, SJR: 0.172, h-index: 29)
Acta Haematologica Polonica     Free   (SJR: 0.123, h-index: 8)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.604, h-index: 38)
Acta Materialia     Hybrid Journal   (Followers: 240, SJR: 3.683, h-index: 202)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 5, SJR: 0.615, h-index: 21)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.442, h-index: 21)
Acta Oecologica     Hybrid Journal   (Followers: 10, SJR: 0.915, h-index: 53)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription   (Followers: 1)
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 3, SJR: 0.311, h-index: 16)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 2)
Acta Poética     Open Access   (Followers: 4)
Acta Psychologica     Hybrid Journal   (Followers: 23, SJR: 1.365, h-index: 73)
Acta Sociológica     Open Access  
Acta Tropica     Hybrid Journal   (Followers: 6, SJR: 1.059, h-index: 77)
Acta Urológica Portuguesa     Open Access  
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 4)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 3)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 4, SJR: 0.383, h-index: 19)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 2)
Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 5, SJR: 0.141, h-index: 3)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 4, SJR: 0.112, h-index: 2)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 4)
Acute Pain     Full-text available via subscription   (Followers: 13)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.967, h-index: 57)
Addictive Behaviors     Hybrid Journal   (Followers: 15, SJR: 1.514, h-index: 92)
Addictive Behaviors Reports     Open Access   (Followers: 5)
Additive Manufacturing     Hybrid Journal   (Followers: 7, SJR: 1.039, h-index: 5)
Additives for Polymers     Full-text available via subscription   (Followers: 21)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 135, SJR: 5.2, h-index: 222)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 11, SJR: 1.265, h-index: 53)
Advanced Powder Technology     Hybrid Journal   (Followers: 17, SJR: 0.739, h-index: 33)
Advances in Accounting     Hybrid Journal   (Followers: 9, SJR: 0.299, h-index: 15)
Advances in Agronomy     Full-text available via subscription   (Followers: 15, SJR: 2.071, h-index: 82)
Advances in Anesthesia     Full-text available via subscription   (Followers: 25, SJR: 0.169, h-index: 4)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 3)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 6, SJR: 1.054, h-index: 35)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 11, SJR: 0.801, h-index: 26)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 22, SJR: 1.286, h-index: 49)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 16, SJR: 3.31, h-index: 42)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.277, h-index: 43)
Advances in Botanical Research     Full-text available via subscription   (Followers: 3, SJR: 0.619, h-index: 48)
Advances in Cancer Research     Full-text available via subscription   (Followers: 25, SJR: 2.215, h-index: 78)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 9, SJR: 0.9, h-index: 30)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 2.139, h-index: 42)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 12)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 26, SJR: 0.183, h-index: 23)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10, SJR: 0.665, h-index: 29)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 9, SJR: 1.268, h-index: 45)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 29, SJR: 0.938, h-index: 33)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 18, SJR: 2.314, h-index: 130)
Advances in Computers     Full-text available via subscription   (Followers: 16, SJR: 0.223, h-index: 22)
Advances in Dermatology     Full-text available via subscription   (Followers: 12)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 11)
Advances in Digestive Medicine     Open Access   (Followers: 6)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 5)
Advances in Drug Research     Full-text available via subscription   (Followers: 22)
Advances in Ecological Research     Full-text available via subscription   (Followers: 41, SJR: 3.25, h-index: 43)
Advances in Engineering Software     Hybrid Journal   (Followers: 25, SJR: 0.486, h-index: 10)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 7)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 41, SJR: 5.465, h-index: 64)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 3)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 50, SJR: 0.674, h-index: 38)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 16)
Advances in Genetics     Full-text available via subscription   (Followers: 15, SJR: 2.558, h-index: 54)
Advances in Genome Biology     Full-text available via subscription   (Followers: 11)
Advances in Geophysics     Full-text available via subscription   (Followers: 6, SJR: 2.325, h-index: 20)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 22, SJR: 0.906, h-index: 24)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 0.497, h-index: 31)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 2, SJR: 0.396, h-index: 27)
Advances in Immunology     Full-text available via subscription   (Followers: 35, SJR: 4.152, h-index: 85)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 1.132, h-index: 42)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 3, SJR: 1.274, h-index: 27)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 6)
Advances in Life Course Research     Hybrid Journal   (Followers: 8, SJR: 0.764, h-index: 15)
Advances in Lipobiology     Full-text available via subscription   (Followers: 2)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 9)
Advances in Marine Biology     Full-text available via subscription   (Followers: 16, SJR: 1.645, h-index: 45)
Advances in Mathematics     Full-text available via subscription   (Followers: 10, SJR: 3.261, h-index: 65)
Advances in Medical Sciences     Hybrid Journal   (Followers: 6, SJR: 0.489, h-index: 25)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 5)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 4, SJR: 1.44, h-index: 51)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 22)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 10)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7, SJR: 0.324, h-index: 8)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 4)
Advances in Oncobiology     Full-text available via subscription   (Followers: 3)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 15, SJR: 2.885, h-index: 45)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 7, SJR: 0.148, h-index: 11)
Advances in Parasitology     Full-text available via subscription   (Followers: 7, SJR: 2.37, h-index: 73)
Advances in Pediatrics     Full-text available via subscription   (Followers: 24, SJR: 0.4, h-index: 28)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 13)
Advances in Pharmacology     Full-text available via subscription   (Followers: 15, SJR: 1.718, h-index: 58)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 0.384, h-index: 26)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.248, h-index: 11)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 8)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 5)
Advances in Porous Media     Full-text available via subscription   (Followers: 4)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 17)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 20, SJR: 1.5, h-index: 62)
Advances in Psychology     Full-text available via subscription   (Followers: 61)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 5, SJR: 0.478, h-index: 32)
Advances in Radiation Oncology     Open Access  
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 3, SJR: 0.1, h-index: 2)
Advances in Space Research     Full-text available via subscription   (Followers: 353, SJR: 0.606, h-index: 65)
Advances in Structural Biology     Full-text available via subscription   (Followers: 8)
Advances in Surgery     Full-text available via subscription   (Followers: 7, SJR: 0.823, h-index: 27)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 30, SJR: 1.321, h-index: 56)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 17)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 13)
Advances in Virus Research     Full-text available via subscription   (Followers: 5, SJR: 1.878, h-index: 68)
Advances in Water Resources     Hybrid Journal   (Followers: 43, SJR: 2.408, h-index: 94)
Aeolian Research     Hybrid Journal   (Followers: 5, SJR: 0.973, h-index: 22)
Aerospace Science and Technology     Hybrid Journal   (Followers: 325, SJR: 0.816, h-index: 49)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.318, h-index: 36)
African J. of Emergency Medicine     Open Access   (Followers: 5, SJR: 0.344, h-index: 6)
Ageing Research Reviews     Hybrid Journal   (Followers: 8, SJR: 3.289, h-index: 78)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 405, SJR: 1.385, h-index: 72)
Agri Gene     Hybrid Journal  
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 15, SJR: 2.18, h-index: 116)
Agricultural Systems     Hybrid Journal   (Followers: 30, SJR: 1.275, h-index: 74)
Agricultural Water Management     Hybrid Journal   (Followers: 39, SJR: 1.546, h-index: 79)
Agriculture and Agricultural Science Procedia     Open Access  
Agriculture and Natural Resources     Open Access   (Followers: 1)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 54, SJR: 1.879, h-index: 120)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.434, h-index: 14)
Air Medical J.     Hybrid Journal   (Followers: 5, SJR: 0.234, h-index: 18)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.285, h-index: 3)
Alcohol     Hybrid Journal   (Followers: 10, SJR: 0.922, h-index: 66)
Alcoholism and Drug Addiction     Open Access   (Followers: 8)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 1, SJR: 0.436, h-index: 12)
Alexandria J. of Medicine     Open Access  
Algal Research     Partially Free   (Followers: 8, SJR: 2.05, h-index: 20)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 3)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.46, h-index: 29)
Allergology Intl.     Open Access   (Followers: 4, SJR: 0.776, h-index: 35)
Alpha Omegan     Full-text available via subscription   (SJR: 0.121, h-index: 9)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 8, SJR: 0.158, h-index: 9)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 48, SJR: 4.289, h-index: 64)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 6)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 5)
American Heart J.     Hybrid Journal   (Followers: 49, SJR: 3.157, h-index: 153)
American J. of Cardiology     Hybrid Journal   (Followers: 47, SJR: 2.063, h-index: 186)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 39, SJR: 0.574, h-index: 65)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 8, SJR: 1.091, h-index: 45)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 15, SJR: 1.653, h-index: 93)
American J. of Human Genetics     Hybrid Journal   (Followers: 31, SJR: 8.769, h-index: 256)
American J. of Infection Control     Hybrid Journal   (Followers: 25, SJR: 1.259, h-index: 81)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 32, SJR: 2.313, h-index: 172)
American J. of Medicine     Hybrid Journal   (Followers: 45, SJR: 2.023, h-index: 189)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 237, SJR: 2.255, h-index: 171)
American J. of Ophthalmology     Hybrid Journal   (Followers: 57, SJR: 2.803, h-index: 148)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 5)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.249, h-index: 88)
American J. of Otolaryngology     Hybrid Journal   (Followers: 25, SJR: 0.59, h-index: 45)
American J. of Pathology     Hybrid Journal   (Followers: 26, SJR: 2.653, h-index: 228)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 22, SJR: 2.764, h-index: 154)
American J. of Surgery     Hybrid Journal   (Followers: 34, SJR: 1.286, h-index: 125)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, SJR: 0.653, h-index: 70)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 5)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.066, h-index: 51)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 57, SJR: 0.124, h-index: 9)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 11)
Anales de Cirugia Vascular     Full-text available via subscription  
Anales de Pediatría     Full-text available via subscription   (Followers: 2, SJR: 0.209, h-index: 27)
Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription   (SJR: 0.104, h-index: 3)
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 4, SJR: 2.577, h-index: 7)
Analytica Chimica Acta     Hybrid Journal   (Followers: 37, SJR: 1.548, h-index: 152)
Analytical Biochemistry     Hybrid Journal   (Followers: 166, SJR: 0.725, h-index: 154)
Analytical Chemistry Research     Open Access   (Followers: 8, SJR: 0.18, h-index: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 11)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 1)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 22, SJR: 0.421, h-index: 40)
Angiología     Full-text available via subscription   (SJR: 0.124, h-index: 9)
Angiologia e Cirurgia Vascular     Open Access  
Animal Behaviour     Hybrid Journal   (Followers: 160, SJR: 1.907, h-index: 126)
Animal Feed Science and Technology     Hybrid Journal   (Followers: 5, SJR: 1.151, h-index: 83)
Animal Reproduction Science     Hybrid Journal   (Followers: 5, SJR: 0.711, h-index: 78)
Annales d'Endocrinologie     Full-text available via subscription   (Followers: 1, SJR: 0.394, h-index: 30)
Annales d'Urologie     Full-text available via subscription  
Annales de Cardiologie et d'Angéiologie     Full-text available via subscription   (SJR: 0.177, h-index: 13)
Annales de Chirurgie de la Main et du Membre Supérieur     Full-text available via subscription  
Annales de Chirurgie Plastique Esthétique     Full-text available via subscription   (Followers: 2, SJR: 0.354, h-index: 22)
Annales de Chirurgie Vasculaire     Full-text available via subscription   (Followers: 1)

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Journal Cover American Journal of Ophthalmology
  [SJR: 2.803]   [H-I: 148]   [57 followers]  Follow
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 0002-9394
   Published by Elsevier Homepage  [3043 journals]
  • Preoperative Bevacizumab Administration in Proliferative Diabetic
           Retinopathy Patients Undergoing Vitrectomy: A Randomized and Controlled
           Trial Comparing Interval Variation
    • Authors: Javier Castillo; Isaac Aleman; Sloan W. Rush; Ryan B. Rush
      Pages: 1 - 10
      Abstract: Publication date: November 2017
      Source:American Journal of Ophthalmology, Volume 183
      Author(s): Javier Castillo, Isaac Aleman, Sloan W. Rush, Ryan B. Rush
      Purpose To assess the optimal interval of preoperative intravitreal bevacizumab (IVB) administration in diabetic subjects undergoing pars plana vitrectomy (PPV) for severe manifestations of active proliferative diabetic retinopathy (PDR). Design Randomized clinical trial. Methods One hundred and fifty-six patients with PDR-related complications requiring PPV were prospectively randomized into 1 of 2 treatment groups: Group A received IVB (2.5 mg/0.1 mL) 1–3 days before PPV, while Group B received IVB (2.5 mg/0.1 mL) 5–10 days before PPV. The primary outcome was best-corrected visual acuity (BCVA) at 6 months follow-up. Secondary outcome measures were intraoperative surgery time, intraoperative complications, postoperative complications, and incidence of unplanned PPV at 6 months follow-up. Results One hundred and twenty-five subjects underwent PPV and completed the 6-month follow-up interval. Group B patients had better final BCVA (P = .033) and were less likely to have a postoperative complication (P = .018) when compared to Group A patients. The mean difference in final BCVA between groups was 0.22 logMAR (95% confidence interval: 0.02–0.43, P = .017). Group A was 3.90 (95% confidence interval: 1.08–17.31, P = .046) times more likely to have a loss of 1 or more logMAR lines of final BCVA when compared to Group B. There were no significant differences among the treatment groups with regard to baseline features, intraoperative surgery time, intraoperative complications, and incidence of unplanned PPV during the study interval. Conclusions This randomized clinical trial demonstrated better postoperative outcomes at 6 months when subjects received preoperative IVB 5–10 days before PPV compared to 1–3 days for the treatment of PDR-related complications.

      PubDate: 2017-09-14T02:13:10Z
      DOI: 10.1016/j.ajo.2017.08.013
      Issue No: Vol. 183 (2017)
  • Pediatric Corneal Cross-linking: Comparison of Visual and Topographic
           Outcomes Between Conventional and Accelerated Treatment
    • Authors: Philipp B. Baenninger; Lucas M. Bachmann; Ludmilla Wienecke; Michael A. Thiel; Claude Kaufmann
      Pages: 11 - 16
      Abstract: Publication date: November 2017
      Source:American Journal of Ophthalmology, Volume 183
      Author(s): Philipp B. Baenninger, Lucas M. Bachmann, Ludmilla Wienecke, Michael A. Thiel, Claude Kaufmann
      Purpose To compare visual and topographic outcomes 1 year after conventional (C-CXL) vs accelerated corneal cross-linking (A-CXL) in pediatric keratoconus (KC). Design Comparative, retrospective, consecutive case series. Methods Patients with topography-confirmed, progressive KC and a corneal thickness of ≥400 μm at the time of surgery were enrolled. Uncorrected (UCVA) and best phoropter-corrected visual acuity (BCVA) and normal maximum keratometry reading (Kmax) were measured at study entry and at the 12-month follow-up. Treatment failure rate was defined as the percentage of eyes with an increase in Kmax of more than 1.0 diopter during follow-up. The adverse event rate was the percentage of eyes with a loss of ≥2 Snellen lines of BCVA from baseline. This was a single-center analysis of 78 eyes of 58 patients that underwent C-CXL (39 eyes) and A-CXL (39 eyes). No eyes were lost to follow-up after 12 months. Results No significant difference between changes in 12 months after as compared to the time before CXL for UCVA (0.01 log MAR; 95% confidence interval −0.14 to 0.15, P = .944), BCVA (0.05 log MAR; 95% confidence interval −0.05 to 0.15, P = .310), and Kmax (−0.77 diopters; 95% confidence interval −2.20 to 0.65, P = .282) between the C-CXL and A-CXL group were observed. Treatment failure rate was observed in 9 of 39 eyes (23.1%) in C-CXL and in 6 of 39 eyes (15.4%) in A-CXL (P = .389). Adverse events were seen only in 1 eye in the C-CXL group. Conclusions In this retrospective comparison, the accelerated approach was equally as effective as the conventional protocol to treat pediatric keratoconus.

      PubDate: 2017-09-14T02:13:10Z
      DOI: 10.1016/j.ajo.2017.08.015
      Issue No: Vol. 183 (2017)
  • Circumferential Trabeculotomy Versus Conventional Angle Surgery: Comparing
           Long-term Surgical Success and Clinical Outcomes in Children With Primary
           Congenital Glaucoma
    • Authors: Rebecca F. Neustein; Allen D. Beck
      Pages: 17 - 24
      Abstract: Publication date: November 2017
      Source:American Journal of Ophthalmology, Volume 183
      Author(s): Rebecca F. Neustein, Allen D. Beck
      Purpose This study compares the long-term efficacy of circumferential trabeculotomy to that of conventional angle surgeries in primary congenital glaucoma (PCG), as judged by glaucoma and visual outcomes. Design Retrospective observational case series. Methods Setting: Emory Eye Center, Atlanta, Georgia. Study Population: This was a single-institution retrospective study involving children with PCG who underwent circumferential trabeculotomy, standard trabeculotomy, or goniotomy with ≥2-year follow-up. Main Outcome Measures: Postoperative success (intraocular pressure [IOP] < 22 mm Hg ± glaucoma medications, without glaucoma progression/additional IOP-lowering surgery), Snellen-equivalent visual acuity (VA), and IOP at last follow-up. Kaplan-Meier method estimated the probability of glaucoma control vs time postoperatively, and values were compared between angle surgery cohorts using Wilcoxon signed rank tests, Mann-Whitney U tests, and Fisher exact tests. Results Included were 58 eyes (33 children) after circumferential trabeculotomy and 42 eyes (27 children) after standard trabeculotomy/goniotomy, with mean follow-up of 7.2 ± 4.0 and 8.2 ± 4.5 years, respectively. Postoperative success at last follow-up in the circumferential vs conventional cohorts was 81% (47 of 58 eyes) vs 31% (13 of 42 eyes) (P < .0001). At last follow-up, the circumferential cohort had better median VA than the conventional cohort (20/30 (interquartile range [IQR] 20/25 to 20/70) vs 20/70 (IQR 20/40 to 20/200), P = .009), required fewer glaucoma medications (0.55 ± 1.2 vs 1.61 ± 1.51, P < .0001), had lower IOP in first operated eye (15.2 ± 3.6 vs 18.2 ± 7.0, P = .048), and had comparable incidence of devastating complications (P = .065). Conclusions In this retrospective study, circumferential trabeculotomy afforded better long-term success and visual outcomes than conventional angle surgery for children with PCG.

      PubDate: 2017-09-19T12:48:47Z
      DOI: 10.1016/j.ajo.2017.08.008
      Issue No: Vol. 183 (2017)
  • Performance and Safety of a New Ab Interno Gelatin Stent in Refractory
           Glaucoma at 12 Months
    • Authors: Davinder S. Grover; William J. Flynn; Kent P. Bashford; Richard A. Lewis; Yi-Jing Duh; Rupali S. Nangia; Barbara Niksch
      Pages: 25 - 36
      Abstract: Publication date: November 2017
      Source:American Journal of Ophthalmology, Volume 183
      Author(s): Davinder S. Grover, William J. Flynn, Kent P. Bashford, Richard A. Lewis, Yi-Jing Duh, Rupali S. Nangia, Barbara Niksch
      Purpose To evaluate the intraocular pressure (IOP)-lowering performance and safety of an ab interno gelatin stent (XEN 45 Gel Stent, Allergan plc, Irvine, California, USA), a minimally invasive glaucoma surgery device, in refractory glaucoma. Design Single-arm, open-label, multicenter clinical study. Methods Following mitomycin C pretreatment, the stent was placed ab interno in patients who failed prior filtering/cilioablative procedure or had uncontrolled IOP on maximum-tolerated medical therapy, with medicated IOP ≥20 and ≤35 mm Hg and visual field mean deviation ≤−3 dB. Primary performance outcomes: patients (%) achieving ≥20% IOP reduction from baseline on the same or fewer medications and mean IOP change from baseline at month 12. Procedure-related complications and ocular adverse events (AEs) were assessed. Results Sixty-five patients were implanted (intent-to-treat/safety population). At 12 months, 75.4% (46/61; observed data) reported ≥20% IOP lowering from baseline on the same or fewer medications. Mean IOP change from baseline was −9.1 mm Hg (95% confidence interval [CI]: −10.7, −7.5) (n = 52; observed data) at 12 months, excluding patients with missing data (n = 4) and those requiring a glaucoma-related secondary surgical intervention (n = 9). Mean medication count decreased from 3.5 (baseline) to 1.7 (12 months). No intraoperative complications or unexpected postoperative AEs were reported. Most AEs were mild/moderate; common AEs included needling (without sight-threatening complications), nonpersistent loss of best-corrected visual acuity, and transient hypotony (requiring no surgical intervention). Conclusions The gelatin stent reduced IOP and medication use without raising unexpected safety concerns, offering a minimally invasive surgical option for refractory glaucoma patients.

      PubDate: 2017-09-19T12:48:47Z
      DOI: 10.1016/j.ajo.2017.07.023
      Issue No: Vol. 183 (2017)
  • Clinical Implications of Direct Immunofluorescence Findings in Patients
           With Ocular Mucous Membrane Pemphigoid
    • Authors: Mary T. Labowsky; Sandra S. Stinnett; Jason Liss; Melissa Daluvoy; Russell P. Hall; Christine Shieh
      Pages: 48 - 55
      Abstract: Publication date: November 2017
      Source:American Journal of Ophthalmology, Volume 183
      Author(s): Mary T. Labowsky, Sandra S. Stinnett, Jason Liss, Melissa Daluvoy, Russell P. Hall, Christine Shieh
      Purpose To examine the clinical implications of positive or negative direct immunofluorescence biopsies (DIF) in patients with clinically typical ocular mucous membrane pemphigoid (MMP). Design Retrospective cohort study. Methods The study population was patients with clinically typical ocular MMP disease with documented DIF results who were followed for at least 1 year at the Duke University multidisciplinary ocular MMP clinic. Data were collected by chart review and included patient demographics, clinical examination findings, and history of autoimmune disease and/or malignancy, as well as topical, systemic, and surgical treatments received. Main outcome measures included MMP Disease Area Index, Foster stages, proportion legally blind, duration of follow-up, and use of systemic immunosuppression and ocular procedures in treatment. Results In multivariable analysis restricted to 55 patients, patients with negative and positive biopsies were similar in the outcome measures; however, positive-biopsy patients were more likely to be treated with systemic immunosuppression and were followed for longer at our clinic. Patients with isolated ocular disease were also more likely to have negative biopsies compared to those who also had extraocular disease. Patients who had conjunctival biopsies were more likely to have a negative direct immunofluorescence result than patients with biopsies from other sites. Conclusions We encourage clinicians and patients to consider treatment with systemic immunosuppression even in the absence of diagnosis confirmation by DIF. Furthermore, this study supports current standard of care to pursue a nonocular biopsy of normal-appearing, perilesional skin or oral mucosa when possible.

      PubDate: 2017-09-26T13:07:19Z
      DOI: 10.1016/j.ajo.2017.08.009
      Issue No: Vol. 183 (2017)
  • Optical Coherence Tomography Angiography and Ultra-widefield Fluorescein
           Angiography for Early Detection of Adolescent Sickle Retinopathy
    • Authors: Daniel A. Pahl; Nancy S. Green; Monica Bhatia; Margaret T. Lee; Jonathan S. Chang; Maureen Licursi; Courtney Briamonte; Elana Smilow; Royce W.S. Chen
      Pages: 91 - 98
      Abstract: Publication date: November 2017
      Source:American Journal of Ophthalmology, Volume 183
      Author(s): Daniel A. Pahl, Nancy S. Green, Monica Bhatia, Margaret T. Lee, Jonathan S. Chang, Maureen Licursi, Courtney Briamonte, Elana Smilow, Royce W.S. Chen
      Purpose Based on standard screening techniques, sickle retinopathy reportedly occurs in 10% of adolescents with sickle cell disease (SCD). We performed a prospective, observational clinical study to determine if ultra-widefield fluorescein angiography (UWFA), spectral-domain optical coherence tomography (SD-OCT), and optical coherence tomography angiography (OCT-A) detect more-frequent retinopathy in adolescents with SCD. Design Cross-sectional study. Methods Setting : Institutional. Subjects : Sixteen adolescents with SCD, aged 10–19 years (mean age 14.9 years), and 5 age-equivalent controls (mean age 17.4 years). Observation Procedures : Examinations including acuity, standard slit-lamp biomicroscopy, UWFA, SD-OCT, and OCT-A were performed. Main Outcome Measures : Sickle retinopathy defined by biomicroscopic changes, Goldberg stages I-V, Penman scale, flow void on OCT-A, or macular thinning on SD-OCT. Results While 22 of 32 SCD eyes (68.8%) had retinopathy on biomicroscopy, by UWFA 4 of 24 (16.7%) SCD eyes had peripheral arterial occlusion (Goldberg I), and 20 of 24 eyes (83.3%) had peripheral arteriovenous anastomoses (Goldberg II) in addition. No patients had Goldberg stages III-V. By SD-OCT and OCT-A, thinning of the macula and flow voids in both the superficial and deep retinal capillary plexus were found in 6 of 30 (20%) eyes. Conclusions All 24 eyes with adequate UWFA studies demonstrated sickle retinopathy. SD-OCT and OCT-A, which have not been previously reported in the adolescent population, detected abnormal macular thinning and flow abnormalities undetected by biomicroscopy. These findings suggest that pediatric sickle retinopathy may be more prevalent than previously suspected. If these findings are confirmed with larger cross-sectional and prospective analyses, these approaches may enhance early screening for sickle retinopathy.

      PubDate: 2017-09-26T13:07:19Z
      DOI: 10.1016/j.ajo.2017.08.010
      Issue No: Vol. 183 (2017)
  • The Effect of Pulsing on Transverse Ultrasound Efficiency and Chatter
    • Authors: Alex J. Wright; Austin D. Bohner; Ashlie A. Bernhisel; Brian Zaugg; William R. Barlow; Jeff H. Pettey; Randall J. Olson
      Pages: 107 - 110
      Abstract: Publication date: November 2017
      Source:American Journal of Ophthalmology, Volume 183
      Author(s): Alex J. Wright, Austin D. Bohner, Ashlie A. Bernhisel, Brian Zaugg, William R. Barlow, Jeff H. Pettey, Randall J. Olson
      Purpose To evaluate the effects of micropulse, long pulse, and continuous ultrasound on transverse ultrasound using Abbott Medical Optics' (AMO) WhiteStar Signature Pro with the Ellips FX handpiece. Design In vitro laboratory study. Methods This study was conducted at the John A. Moran Eye Center Laboratory, University of Utah, Salt Lake City, Utah, USA. Porcine lenses were hardened in formalin for 2 hours and equilibrated in basic salt solution (BSS) over a 24-hour period. The lenses were then cubed in 2.0 × 2.0-mm pieces. These pieces were stored in BSS until the time of experimentation. The AMO WhiteStar Signature Pro machine (Abbott Medical Optics) with the Ellips FX handpiece and a 0.9-mm bent Dewey tip with a 30-degree bevel (Microsurgical Technology Inc) were used for phacoemulsification. Three runs of 20 lenses each were performed, measuring efficiency and chatter. Transverse ultrasound varied in the 3 runs and included continuous, 6 ms on/off micropulse, and 50 ms on/off long pulse. Results Micropulse was more efficient than long pulse by 43% (P = .00003) and continuous by 42% (P = .000387). There were also less chatter events with micropulse than with long-pulse and continuous ultrasound. However, this difference did not reach significance. Conclusion The 6 ms on and 6 ms off micropulse transverse 3-dimensional ultrasound is more efficient and produces fewer chatter events than both long-pulse and continuous ultrasound.

      PubDate: 2017-10-02T13:40:01Z
      DOI: 10.1016/j.ajo.2017.08.012
      Issue No: Vol. 183 (2017)
  • One- Versus Two-Muscle Surgery for Presumed Unilateral Fourth Nerve Palsy
           Associated With Moderate Angle Hyperdeviations
    • Authors: David L. Nash; Sarah R. Hatt; David A. Leske; Laura May; Erick D. Bothun; Brian G. Mohney; Michael C. Brodsky; Jonathan M. Holmes
      Pages: 1 - 7
      Abstract: Publication date: October 2017
      Source:American Journal of Ophthalmology, Volume 182
      Author(s): David L. Nash, Sarah R. Hatt, David A. Leske, Laura May, Erick D. Bothun, Brian G. Mohney, Michael C. Brodsky, Jonathan M. Holmes
      Purpose To compare 1-muscle vs 2-muscle surgery for moderate-angle hyperdeviations owing to presumed unilateral fourth nerve palsy. Design Retrospective chart review. Methods Seventy-three patients (aged 5–86 years) underwent either 1- or 2-muscle surgery at our institution for moderate hyperdeviation owing to presumed unilateral fourth nerve palsy, measuring 14–25 prism diopters (PD) in straight-ahead gaze at distance fixation. Six-week and 1-year motor success was defined as zero vertical deviation or 1–4 PD undercorrection at distance, overcorrection as any reversal of hypertropia, and undercorrection as >4 PD. Diplopia success was defined as no diplopia, or only rarely for distance straight ahead and reading. Results Twenty-eight patients underwent 1-muscle surgery, and 45 patients underwent 2-muscle surgery. Motor success was similar (64% vs 67%, P > .99 at 6 weeks; 47% vs 55%, P = .8 at 1 year, n = 46), but there were more undercorrections at 6 weeks with 1-muscle surgery (36% vs 16%, P = .09) and more overcorrections at 6 weeks with 2-muscle surgery (0% vs 18%, P = .02). Diplopia success was also somewhat similar between 1- and 2-muscle surgery at 6 weeks (73% vs 60%, P = .5) and 1 year (45% vs 59%, P = .5). Conclusion For moderate-angle hyperdeviations owing to presumed unilateral fourth nerve palsy, there appears no clear advantage of 2-muscle surgery for motor outcomes. Diplopia success was similar between 1- and 2-muscle surgery, owing to a greater number of less symptomatic undercorrections with 1-muscle surgery and a smaller number of more symptomatic overcorrections with 2-muscle surgery.

      PubDate: 2017-08-14T00:38:04Z
      DOI: 10.1016/j.ajo.2017.06.030
      Issue No: Vol. 182 (2017)
  • Conjunctival Autograft Versus Amniotic Membrane Transplantation for
           Treatment of Pterygium: Findings From a Cochrane Systematic Review
    • Authors: Elizabeth Clearfield; Barbara S. Hawkins; Irene C. Kuo
      Pages: 8 - 17
      Abstract: Publication date: October 2017
      Source:American Journal of Ophthalmology, Volume 182
      Author(s): Elizabeth Clearfield, Barbara S. Hawkins, Irene C. Kuo
      Purpose To summarize key findings from a systematic review of the effectiveness and risks of conjunctival autograft (CAG) compared with amniotic membrane transplant (AMT) for pterygium. Design Cochrane systematic review. Methods We included only randomized controlled trials (RCTs) in which CAG and AMT had been compared for primary or recurrent pterygia. The primary outcome was recurrence of pterygium ≥1 mm onto the cornea by 3 and 6 months post surgery. We adhered to Cochrane methods for trial selection, data extraction, risk of bias evaluation, and data synthesis. Results Twenty RCTs with 1866 participants (1947 eyes) were included. Pterygium recurrence 6 months after surgery ranged from 3.3% to 16.7% in the CAG group and 6.4% to 42.3% in the AMT group based on data from 1021 eyes in 10 RCTs. Estimated risk ratios from meta-analysis indicated that CAG-treated eyes had a 47% lower risk of recurrence 6 months after surgery compared with the AMT group (RR, 0.53, 95% confidence interval [CI], 0.33–0.85). For 96 eyes with recurrent pterygium, the risk of recurrence 6 months after CAG was reduced by 55% compared with AMT (risk ratio [RR], 0.45, 95% CI, 0.21–0.99). Three-month recurrence rates were similar for CAG and AMT based on data from 538 eyes (6 RCTs). Conclusions CAG was more effective than AMT to prevent pterygium recurrence by 6 months post surgery, especially in recurrent pterygia. CAG-treated eyes had half the recurrence rates of AMT-treated eyes. Future RCTs should assess changes in patient-reported outcomes (symptoms, cosmesis) and visual acuity, and evaluate effects of surgical variations.

      PubDate: 2017-08-14T00:38:04Z
      DOI: 10.1016/j.ajo.2017.07.004
      Issue No: Vol. 182 (2017)
  • Incidence and Types of Pediatric Nystagmus
    • Authors: David L. Nash; Nancy N. Diehl; Brian G. Mohney
      Pages: 31 - 34
      Abstract: Publication date: October 2017
      Source:American Journal of Ophthalmology, Volume 182
      Author(s): David L. Nash, Nancy N. Diehl, Brian G. Mohney
      Purpose To report the incidence, prevalent subtypes, and clinical characteristics of pediatric nystagmus diagnosed over a 30-year period. Design Retrospective, population-based study. Methods Using the Rochester Epidemiology Project, we reviewed the medical records of all children (<19 years) diagnosed as residents in Olmsted County, Minnesota, with any form of nystagmus from January 1, 1976, through December 31, 2005. Results Seventy-one children were diagnosed during the 30-year period, yielding an annual incidence of 6.72 per 100,000 younger than 19 years (95% confidence interval [CI], 5.15–8.28) Infantile nystagmus, onset by 6 months, comprised 62 (87.3%) of the study patients, corresponding to a birth prevalence of 1 in 821. The median age at diagnosis for the cohort was 12.7 months (range, 0 days to 18.6 years) and 42 subjects (59.2%) were male. The main types of nystagmus, in declining order, were nystagmus associated with retinal/optic nerve disease in 23 (32.4%), idiopathic or congenital motor nystagmus in 22 (31.0%), manifest latent nystagmus or latent nystagmus in 17 (24.0%), and 2 (2.8%) each associated with Chiari malformation, medication use, tumor of the central nervous system, and no diagnosis. Developmental delay was diagnosed in 31 (43.6%), strabismus in 25 (35.2%), and amblyopia in 10 (14.1%). Eighty percent had 20/40 (or equivalent) or better vision at presentation in at least 1 eye. Conclusions This study provides population-based data on incidence and clinical characteristics of childhood nystagmus in North America. Idiopathic and nystagmus associated with retinal/optic nerve disease were the most common presentations, with most patients having good vision. Developmental delay, strabismus, and amblyopia were common in this cohort.

      PubDate: 2017-08-24T01:07:54Z
      DOI: 10.1016/j.ajo.2017.07.006
      Issue No: Vol. 182 (2017)
  • Detection of Functional Change in Preperimetric and Perimetric Glaucoma
           Using 10-2 Matrix Perimetry
    • Authors: Kyoung In Jung; Chan Kee Park
      Pages: 35 - 44
      Abstract: Publication date: October 2017
      Source:American Journal of Ophthalmology, Volume 182
      Author(s): Kyoung In Jung, Chan Kee Park
      Purpose To evaluate an effective functional strategy for detecting glaucomatous damage of the macula in preperimetric to perimetric glaucoma. Design Cross-sectional study. Methods Preperimetric glaucoma patients (n = 102) and perimetric glaucoma patients (n = 88) with isolated paracentral scotoma or combined paracentral scotoma were enrolled in this study. Global and sectoral mean sensitivities (MS) were evaluated using 10-2 standard automated perimetry (SAP) with a stimulus of sizes III (0.43-degree diameter) and V (1.72 degrees), and 10-2 Matrix perimetry with a stimulus of 2 degrees. Ganglion cell–inner plexiform layer (GCIPL) was measured using spectral-domain optical coherence tomography. Results The percentage of significantly depressed visual field (VF) points <5% and <1% in the pattern deviation plot was higher with frequency doubling technology (FDT) 10-2 than with SAP 10-2 III in patients with preperimetric glaucoma (both P < .001). Using FDT 10-2 tests, the global structure-function correlation was superior to SAP 10-2 (III or V) in both preperimetric and perimetric glaucoma. Topographic structure-function relationships for each VF test were more favorable with the FDT 10-2 test. The preperimetric glaucoma patients showing VF abnormalities on FDT 10-2 or SAP 10-2 (III) showed thinner average, minimum, superior, inferior, and inferotemporal GCIPL thicknesses than in those without VF abnormalities (all P < .05). Conclusions FDT 10-2 was found to detect functional damage of the macula early in preperimetric glaucoma, and to perform better than with SAP 10-2 (size III or V) from preperimetric to perimetric glaucoma in the structure-function relationship. FDT 10-2 can be considered a useful tool to detect glaucomatous damage of the macula early and appropriately.

      PubDate: 2017-08-24T01:07:54Z
      DOI: 10.1016/j.ajo.2017.07.007
      Issue No: Vol. 182 (2017)
  • Treatment-Naïve Quiescent Choroidal Neovascularization in Geographic
           Atrophy Secondary to Nonexudative Age-Related Macular Degeneration
    • Authors: Vittorio Capuano; Alexandra Miere; Lea Querques; Riccardo Sacconi; Adriano Carnevali; Francesca Amoroso; Francesco Bandello; Eric H. Souied; Giuseppe Querques
      Pages: 45 - 55
      Abstract: Publication date: October 2017
      Source:American Journal of Ophthalmology, Volume 182
      Author(s): Vittorio Capuano, Alexandra Miere, Lea Querques, Riccardo Sacconi, Adriano Carnevali, Francesca Amoroso, Francesco Bandello, Eric H. Souied, Giuseppe Querques
      Purpose To describe the characteristics and natural history of quiescent choroidal neovascularization (CNV) in geographic atrophy (GA) secondary to nonexudative age-related macular degeneration (AMD) through multimodal imaging. Design Retrospective observational case series. Methods Patients diagnosed with quiescent CNV were analyzed in 2 high-volume referral centers. Imaging features obtained using fluorescein angiography (FA), indocyanine green angiography (ICGA), structural optical coherence tomography (OCT), and OCT angiography (OCT-A) were noted at first presentation and during the study period. Results Nineteen eyes of 19 patients were included. Mean (+SD) follow-up was 45.7 ± 14.7 months. Quiescent CNV appeared as an ill-defined hyperfluorescent lesion without leakage or pooling of dye in the late phase of FA. On ICGA, quiescent CNV appeared as a distinct area of hyperfluorescence (vascular network) in early to intermediate frames and as a hyperfluorescent plaque in the late frame (late plaque). OCT-A revealed a flow signal beneath the small irregular elevation of the retinal pigment epithelium at the site of the quiescent CNV visualized by structural OCT. During the study period, 5 of the 19 CNV patients developed exudation. The remainder showed specific alterations in both structural OCT and OCT-A imaging. At last follow-up, 92% of the quiescent CNV seemed to cover the area spared from atrophy. Conclusions The characteristics of the quiescent CNVs were very similar to those already described for intermediate AMD, although they had several specific features in the context of GA.

      PubDate: 2017-08-24T01:07:54Z
      DOI: 10.1016/j.ajo.2017.07.009
      Issue No: Vol. 182 (2017)
  • Long-term Visual Outcomes Comparing Descemet Stripping Automated
           Endothelial Keratoplasty and Penetrating Keratoplasty
    • Authors: Matthias Fuest; Marcus Ang; Hla Myint Htoon; Donald Tan; Jodhbir S. Mehta
      Pages: 62 - 71
      Abstract: Publication date: October 2017
      Source:American Journal of Ophthalmology, Volume 182
      Author(s): Matthias Fuest, Marcus Ang, Hla Myint Htoon, Donald Tan, Jodhbir S. Mehta
      Purpose To compare 5-year visual acuity and refraction outcome in Descemet stripping automated endothelial keratoplasty (DSAEK) and penetrating keratoplasty (PK) for Fuchs endothelial dystrophy (FED) or bullous keratopathy (BK) in Asian eyes. Design Prospective interventional case series. Methods We analyzed 828 consecutive cases of DSAEK (423) or PK (405) for FED and BK from the Singapore Cornea Transplant Registry performed from 1991 to 2011. Our main outcome measures were best spectacle-corrected visual acuity (BSCVA) with astigmatism (cylinder) and spherical equivalent (SE) over 5 years of follow-up. Results Mean age was 67.5 ± 11.5 years (50.1% male, 49.9% female) and majority was Chinese (76.6%, n = 634) in our multiracial Asian population. DSAEK eyes had significantly better BSCVA (P < .001–.037) with lower SE (P < .001–.017) and cylinder (P < .001), independent of surgical indication, compared to PK over 5 years. DSAEK was superior to PK over 5 years (P < .001–.026) in FED, but only over 3 years in BK (P < .001–.031). DSAEK in FED eyes had significantly better BSCVA compared to BK eyes (P = .006 at 4-year follow-up). DSAEKs with preoperative BSCVA < 1.3 logMAR had significantly better visual outcomes than cases with ≥ 1.3 logMAR (P < .001–.042). PKs had significantly higher postoperative refractive correction than DSAEKs, with no significant influence of the surgery indication. Conclusions In our study cohort, DSAEK provided significantly better long-term BSCVA and lower astigmatism than PK over 5 years of follow-up. Visual outcomes of DSAEK for FED were better than BK. In some analyses for years 1–3, analysis of covariance adjustment indicated that this DSAEK-associated better long-term BSCVA was independent of better preoperative vision in DSAEK eyes.

      PubDate: 2017-09-03T01:35:15Z
      DOI: 10.1016/j.ajo.2017.07.014
      Issue No: Vol. 182 (2017)
  • Quantitative Retinal Vascular Changes in Obstructive Sleep Apnea
    • Authors: Jessica Y. Tong; Mojtaba Golzan; Dana Georgevsky; Jonathan P. Williamson; Stuart L. Graham; Claude S. Farah; Clare L. Fraser
      Pages: 72 - 80
      Abstract: Publication date: October 2017
      Source:American Journal of Ophthalmology, Volume 182
      Author(s): Jessica Y. Tong, Mojtaba Golzan, Dana Georgevsky, Jonathan P. Williamson, Stuart L. Graham, Claude S. Farah, Clare L. Fraser
      Purpose To examine the relationship between both static and dynamic retinal vascular caliber and the severity of obstructive sleep apnea (OSA). Design Prospective cross-sectional study. Methods Adult patients undergoing diagnostic polysomnography studies at a private Australian university teaching hospital were recruited. OSA severity was defined by the apnea-hypopnea index (AHI): severe >30, moderate >15–30, mild 5–15, and controls <5. Of 115 patients recruited (73 male; mean age 58 ± 13 years), there were 41 severe, 35 moderate, and 25 mild OSA patients and 14 controls. Static retinal vascular caliber was measured as the average diameter of retinal arterioles (CRAE) and venules (CRVE), and summarized as the arteriovenous ratio (AVR). Dynamic retinal vascular caliber was evaluated as the average pulsation amplitude of retinal arterioles (SRAP) and venules (SRVP). Comparisons across groups were performed using multivariate linear regression analysis. All results were adjusted for age, body mass index, and mean arterial pressure. Results Increasing AHI was significantly associated with decreasing AVR (P = .008) and CRAE (P = .016). A significant relationship was demonstrated between increasing AHI and attenuated retinal vascular pulsation amplitude (arterioles P = .028; venules P < .0001). Conclusions Increasing OSA severity is independently associated with retinal arteriolar narrowing and attenuated vascular pulsation amplitude. The retinal vasculature is easily imaged, and may be a surrogate biomarker of cerebral and systemic vascular risk in patients with OSA requiring further comprehensive investigation.

      PubDate: 2017-09-03T01:35:15Z
      DOI: 10.1016/j.ajo.2017.07.012
      Issue No: Vol. 182 (2017)
  • Development of Refractive Errors—What Can We Learn From Inherited
           Retinal Dystrophies'
    • Authors: Michelle Hendriks; Virginie J.M. Verhoeven; Gabriëlle H.S. Buitendijk; Jan Roelof Polling; Magda A. Meester-Smoor; Albert Hofman; Maarten Kamermans; L. Ingeborgh van den Born; Caroline C.W. Klaver; Ramon A. van Huet; B. Jeroen Klevering; Nathalie M. Bax; Stanley Lambertus; Caroline C.W. Klaver; Carel B. Hoyng; Clasien J. Oomen; Wendy A. van Zelst-Stams; Frans P. Cremers; Astrid S. Plomp; Mary J. van Schooneveld; Mies M. van Genderen; José Schuil; F. Nienke Boonstra; Reinier O. Schlingemann; Arthur A. Bergen; Laurence Pierrache; Magda Meester-Smoor; L. Ingeborgh van den Born; Camiel J. Boon; Jan W.R. Pott; Redmer van Leeuwen; Hester Y. Kroes; Yvonne de Jong-Hesse
      Pages: 81 - 89
      Abstract: Publication date: October 2017
      Source:American Journal of Ophthalmology, Volume 182
      Author(s): Michelle Hendriks, Virginie J.M. Verhoeven, Gabriëlle H.S. Buitendijk, Jan Roelof Polling, Magda A. Meester-Smoor, Albert Hofman, Maarten Kamermans, L. Ingeborgh van den Born, Caroline C.W. Klaver
      Purpose It is unknown which retinal cells are involved in the retina-to-sclera signaling cascade causing myopia. As inherited retinal dystrophies (IRD) are characterized by dysfunction of a single retinal cell type and have a high risk of refractive errors, a study investigating the affected cell type, causal gene, and refractive error in IRDs may provide insight herein. Design Case-control study. Methods Study Population : Total of 302 patients with IRD from 2 ophthalmogenetic centers in the Netherlands. Reference Population : Population-based Rotterdam Study-III and Erasmus Rucphen Family Study (N = 5550). Distributions and mean spherical equivalent (SE) were calculated for main affected cell type and causal gene; and risks of myopia and hyperopia were evaluated using logistic regression. Results Bipolar cell-related dystrophies were associated with the highest risk of SE high myopia 239.7; odds ratio (OR) mild hyperopia 263.2, both P < .0001; SE −6.86 diopters (D) (standard deviation [SD] 6.38), followed by cone-dominated dystrophies (OR high myopia 19.5, P < .0001; OR high hyperopia 10.7, P = .033; SE −3.10 D [SD 4.49]); rod dominated dystrophies (OR high myopia 10.1, P < .0001; OR high hyperopia 9.7, P = .001; SE −2.27 D [SD 4.65]), and retinal pigment epithelium (RPE)-related dystrophies (OR low myopia 2.7; P = .001; OR high hyperopia 5.8; P = .025; SE −0.10 D [SD 3.09]). Mutations in RPGR (SE −7.63 D [SD 3.31]) and CACNA1F (SE −5.33 D [SD 3.10]) coincided with the highest degree of myopia and in CABP4 (SE 4.81 D [SD 0.35]) with the highest degree of hyperopia. Conclusions Refractive errors, in particular myopia, are common in IRD. The bipolar synapse and the inner and outer segments of the photoreceptor may serve as critical sites for myopia development.

      PubDate: 2017-09-03T01:35:15Z
      DOI: 10.1016/j.ajo.2017.07.008
      Issue No: Vol. 182 (2017)
  • Glaucoma Screening in Nepal: Cup-to-Disc Estimate With Standard Mydriatic
           Fundus Camera Compared to Portable Nonmydriatic Camera
    • Authors: Sarah E. Miller; Suman Thapa; Alan L. Robin; Leslie M. Niziol; Pradeep Y. Ramulu; Maria A. Woodward; Indira Paudyal; Ian Pitha; Tyson N. Kim; Paula Anne Newman-Casey
      Pages: 99 - 106
      Abstract: Publication date: October 2017
      Source:American Journal of Ophthalmology, Volume 182
      Author(s): Sarah E. Miller, Suman Thapa, Alan L. Robin, Leslie M. Niziol, Pradeep Y. Ramulu, Maria A. Woodward, Indira Paudyal, Ian Pitha, Tyson N. Kim, Paula Anne Newman-Casey
      Purpose To compare cup-to-disc ratio (CDR) measurements from images taken with a portable, 45-degree nonmydriatic fundus camera to images from a traditional tabletop mydriatic fundus camera. Design Prospective, cross-sectional, comparative instrument validation study. Methods Setting : Clinic-based. Study Population : A total of 422 eyes of 211 subjects were recruited from the Tilganga Institute of Ophthalmology (Kathmandu, Nepal). Two masked readers measured CDR and noted possible evidence of glaucoma (CDR ≥ 0.7 or the presence of a notch or disc hemorrhage) from fundus photographs taken with a nonmydriatic portable camera and a mydriatic standard camera. Each image was graded twice. Main Outcome Measures : Effect of camera modality on CDR measurement; inter- and intraobserver agreement for each camera for the diagnosis of glaucoma. Results A total of 196 eyes (46.5%) were diagnosed with glaucoma by chart review; 41.2%–59.0% of eyes were remotely diagnosed with glaucoma over grader, repeat measurement, and camera modality. There was no significant difference in CDR measurement between cameras after adjusting for grader and measurement order (estimate = 0.004, 95% confidence interval [CI], 0.003–0.011, P = .24). There was moderate interobserver reliability for the diagnosis of glaucoma (Pictor: κ = 0.54, CI, 0.46–0.61; Topcon: κ = 0.63, CI, 0.55–0.70) and moderate intraobserver agreement upon repeat grading (Pictor: κ = 0.63 and 0.64, for graders 1 and 2, respectively; Topcon: κ = 0.72 and 0.80, for graders 1 and 2, respectively). Conclusions A portable, nonmydriatic, fundus camera can facilitate remote evaluation of disc images on par with standard mydriatic fundus photography.

      PubDate: 2017-09-26T13:07:19Z
      DOI: 10.1016/j.ajo.2017.07.010
      Issue No: Vol. 182 (2017)
  • Progressive Macula Vessel Density Loss in Primary Open-Angle Glaucoma: A
           Longitudinal Study
    • Authors: Takuhei Shoji; Linda M. Zangwill; Tadamichi Akagi; Luke J. Saunders; Adeleh Yarmohammadi; Patricia Isabel C. Manalastas; Rafaella C. Penteado; Robert N. Weinreb
      Pages: 107 - 117
      Abstract: Publication date: October 2017
      Source:American Journal of Ophthalmology, Volume 182
      Author(s): Takuhei Shoji, Linda M. Zangwill, Tadamichi Akagi, Luke J. Saunders, Adeleh Yarmohammadi, Patricia Isabel C. Manalastas, Rafaella C. Penteado, Robert N. Weinreb
      Purpose To characterize the rate of macula vessel density loss in primary open-angle glaucoma (POAG), glaucoma-suspect, and healthy eyes. Design Longitudinal, observational cohort from the Diagnostic Innovations in Glaucoma Study. Methods One hundred eyes (32 POAG, 30 glaucoma-suspect, and 38 healthy) followed for at least 1 year with optical coherence tomography angiography (OCT-A) imaging on at least 2 visits were included. Vessel density was calculated in the macula superficial layer. The rate of change was compared across diagnostic groups using a multivariate linear mixed-effects model. Results Baseline macula vessel density was highest in healthy eyes, followed by glaucoma-suspect and POAG eyes (P < .01). The rate of vessel density loss was significantly different from zero in the POAG, but not in the glaucoma-suspect or healthy eyes. The mean rate of change in macula whole en face vessel density was significantly faster in glaucoma eyes (−2.23%/y) than in glaucoma-suspect (0.87%/y, P = .001) or healthy eyes (0.29%/y, P = .004). Conversely, the rate of change in ganglion cell complex (GCC) thickness was not significantly different from zero in any diagnostic group, and no significant differences in the rate of GCC change among diagnostic groups were found. Conclusions With a mean follow-up of less than 14 months, eyes with POAG had significantly faster loss of macula vessel density than either glaucoma-suspect or healthy eyes. Serial OCT-A measurements also detected glaucomatous change in macula vessel density in eyes without evidence of change in GCC thickness.

      PubDate: 2017-09-26T13:07:19Z
      DOI: 10.1016/j.ajo.2017.07.011
      Issue No: Vol. 182 (2017)
  • Retinal Nonperfusion in the Posterior Pole Is Associated With Increased
           Risk of Neovascularization in Central Retinal Vein Occlusion
    • Authors: Luke Nicholson; Clara Vazquez-Alfageme; Namritha V. Patrao; Ioanna Triantafyllopolou; James W. Bainbridge; Philip G. Hykin; Sobha Sivaprasad
      Pages: 118 - 125
      Abstract: Publication date: October 2017
      Source:American Journal of Ophthalmology, Volume 182
      Author(s): Luke Nicholson, Clara Vazquez-Alfageme, Namritha V. Patrao, Ioanna Triantafyllopolou, James W. Bainbridge, Philip G. Hykin, Sobha Sivaprasad
      Purpose To review the definition of ischaemic central retinal vein occlusion (CRVO) and stratify the risk of neovascular complication based on wider areas of visible retinal non-perfusion. Design Retrospective consecutive case series and image analysis study. Methods Setting : Moorfields Eye Hospital, London, United Kingdom. Study Population : Forty-two consecutive treatment-naïve eyes with CRVO imaged with ultra-widefield angiography with a minimum of 12 months follow-up. Observation Procedure : The spatial location and total area of retinal nonperfusion (measured in disc areas, DA) were determined using the validated concentric rings method. The area was corrected for projection distortion. The images were graded by 2 retinal physicians and average measurements used. Main Outcome Measures : Development of neovascular complications. Results The percentage of eyes developing new vessels increased from none in eyes with less than 10 DA of nonperfusion in total to 14.3% in eyes with 10–30 DA, 20.0% for 30–75 DA, and 80% risk with 75–150 DA of nonperfusion. From 13 (31.0%) eyes with a perfused posterior pole (an area encompassing a 5 disc diameter radius centered at the fovea) and more than 10 DA of nonperfusion isolated in the periphery (beyond the posterior pole), only 1 (7.7%) eye developed new vessels, odds ratio (OR) 0.12 [95% confidence interval (CI): 0.01, 1.03]. Comparatively, for 13 (31.0%) eyes with more than 10 DA of nonperfusion in the posterior pole, 11 (84.6%) developed new vessels, OR 74.25 [95% CI: 9.26, 595.30], P < .001. Conclusion With ultra-widefield angiography, we have ascertained that posterior pole nonperfusion of more than 10 DA remains the key risk factor for new vessel development compared to areas of nonperfusion confined to the periphery.

      PubDate: 2017-09-26T13:07:19Z
      DOI: 10.1016/j.ajo.2017.07.015
      Issue No: Vol. 182 (2017)
  • Early Trabeculotomy Ab Externo in Treatment of Sturge-Weber Syndrome
    • Authors: Yue Wu; Rujing Yu; Di Chen; Li Xu; Li Zhu; Mao Li; Chunyu Guo; Ping Gu; Xiaoxi Lin; Wenyi Guo
      Pages: 141 - 146
      Abstract: Publication date: October 2017
      Source:American Journal of Ophthalmology, Volume 182
      Author(s): Yue Wu, Rujing Yu, Di Chen, Li Xu, Li Zhu, Mao Li, Chunyu Guo, Ping Gu, Xiaoxi Lin, Wenyi Guo
      Purpose To evaluate the intermediate-term efficacy and safety of trabeculotomy in infant Sturge-Weber syndrome (SWS). Design Retrospective cohort study. Methods All SWS-induced glaucoma patients less than 12 months of age who underwent trabeculotomy at our Ophthalmology Department from August 2011 to March 2017 were reviewed. Baseline demographics, intraocular pressure (IOP), cup-to-disc ratio (C/D), and cornea diameters were noted before surgery. The IOP, success probabilities, and medication usage were recorded during follow-up until the last visit. Results Overall, 34 eyes (32 patients) were included, with a median surgery age of 3 months and a median follow-up time of 15.5 months. The mean preoperative IOP, asymmetry between 2 eyes, cornea diameter, and median C/D were 21.5 ± 6.6 mm Hg, 10.1 ± 4.9 mm Hg, 12.6 ± 0.7 mm, and 0.65 (interquartile range [IQR]: 0.55, 0.80), respectively. The IOP was significantly reduced from the preoperative baseline at 1 week, 3 months, 6 months, 1 year, and 2 years after the surgery (P < .05). At the last follow-up, the cumulative proportions of overall and complete success were 86.6% and 66.0%, respectively. Complications included a transient shallow anterior chamber. Thirty of the 34 eyes had intraoperative hyphema, 27 of which lasted less than 3 days. No other complications were noted during the follow-up. Conclusions Compared to previous studies with a later diagnosis of glaucoma in SWS patients, better outcomes were achieved with an early diagnosis of glaucoma in SWS patients. Early trabeculotomy ab externo was safe and led to good intermediate-term surgical outcomes for early-onset glaucoma in SWS patients. Higher preoperative IOP and corneal edema were associated with a greater risk of surgery failure.

      PubDate: 2017-09-26T13:07:19Z
      DOI: 10.1016/j.ajo.2017.08.002
      Issue No: Vol. 182 (2017)
  • Disorganization of the Retinal Inner Layers as a Predictor of Visual
           Acuity in Eyes With Macular Edema Secondary to Vein Occlusion
    • Authors: Michael Mimouni; Or Segev; Dalia Dori; Noa Geffen; Victor Flores; Ori Segal
      Pages: 160 - 167
      Abstract: Publication date: Available online 9 October 2017
      Source:American Journal of Ophthalmology
      Author(s): Dan Călugăru, Mihai Călugăru

      PubDate: 2017-10-10T14:05:22Z
      DOI: 10.1016/j.ajo.2017.08.005
      Issue No: Vol. 182 (2017)
  • Corneal Higher-order Aberrations and Visual Improvement Following Corneal
           Transplantation in Treating Herpes Simplex Keratitis
    • Abstract: Publication date: December 2017
      Source:American Journal of Ophthalmology, Volume 184
      Author(s): Eisuke Shimizu, Takefumi Yamaguchi, Daisuke Tomida, Yukari Yagi-Yaguchi, Yoshiyuki Satake, Kazuo Tsubota, Jun Shimazaki
      Purpose To examine corneal higher-order aberrations (HOAs) and visual improvement following corneal transplantation in treating corneal scar caused by herpes simplex keratitis (HSK). Design Retrospective consecutive case series. Methods This study included a total of 52 eyes: 18 eyes of normal subjects, and 34 eyes of consecutive patients with corneal scar owing to HSK who underwent penetrating keratoplasty (PKP, 17 eyes) or deep anterior lamellar keratoplasty (DALK, 17 eyes). HOAs of the anterior, posterior surfaces and the total cornea were analyzed by anterior segment optical coherence tomography. The correlations between corneal HOAs and visual improvement were also analyzed. Results Mean logarithm of the minimal angle of resolution (logMAR) visual acuity significantly improved from 1.40 ± 0.70 to 0.46 ± 0.45 after corneal transplantation (P < .0001). Mean corneal HOAs of the anterior surface significantly decreased after corneal transplantation (PKP: from 1.16 ± 0.59 μm to 0.58 ± 0.35 μm, P = .035, DALK: from 0.94 ± 0.57 μm to 0.37 ± 0.18 μm, P = .004). Visual acuity following corneal transplantation was correlated with the corneal HOAs at 12 months (r = 0.53, P = .01). Visual improvement at 3, 6, and 12 months was positively correlated with preoperative HOAs of the total cornea and posterior surface (all P < .01). Conclusions Preoperative corneal HOAs were associated with the visual improvement in treating corneal scar caused by HSK. Thus, the preoperative assessment of corneal HOAs, especially of the posterior surface, is important in the decision to perform corneal transplantation in eyes with HSK.

      PubDate: 2017-10-18T02:21:47Z
  • Optical Coherence Tomography Protocols for Screening of Hydroxychloroquine
           Retinopathy in Asian Patients
    • Abstract: Publication date: December 2017
      Source:American Journal of Ophthalmology, Volume 184
      Author(s): Seong Joon Ahn, Jooyoung Joung, Han Woong Lim, Byung Ro Lee
      Purpose To investigate the distribution of outer retinal changes in hydroxychloroquine (HCQ) retinopathy and explore optical coherence tomography (OCT) protocols to maximize the sensitivity of HCQ retinopathy detection in Asian patients. Design Diagnostic validity assessment. Methods Setting : Institutional. Patient Population : Forty-eight eyes (24 patients) with HCQ retinopathy underwent 6-mm horizontal and vertical line scans and 6 × 6-mm2 volume scans using spectral-domain OCT (SD-OCT), and 9-mm line scans and 6 × 6-mm2 and 12 × 9-mm2 volume scans using swept-source OCT (SS-OCT). Observation Procedures : Distances from the fovea to the defective photoreceptors were measured in the temporal, nasal, superior, and inferior directions from line scan OCT images. The sensitivity of retinopathy detection, indicated by photoreceptor defects, was compared among protocols. Main Outcome Measures : Detection of photoreceptor defects and distances from the fovea to the defects. Results The average minimum distance from the fovea to an area of photoreceptor defects was 1.84 ± 1.26 mm (mean ± standard deviation). The distances were greater than 3 mm horizontally and vertically in 15 (31.3%) and 17 (35.4%) eyes with HCQ retinopathy, respectively, and only wide-field line or volume scans could detect defects in the eyes. The 9-mm line scans detected HCQ retinopathy significantly better than 6-mm scans (P < .001); the sensitivity of the wide volume scan was significantly greater than the standard volume scan (P = .001). The 12 × 9-mm2 volume scan detected retinopathy with the greatest sensitivity (100%). Conclusions Our study recommends a wide-field OCT scan to screen Asian patients taking HCQ medications.

      PubDate: 2017-10-18T02:21:47Z
  • The ISNT Rule: How Often Does It Apply to Disc Photographs and Retinal
           Nerve Fiber Layer Measurements in the Normal Population'
    • Abstract: Publication date: December 2017
      Source:American Journal of Ophthalmology, Volume 184
      Author(s): Linda Yi-Chieh Poon, David Solá-Del Valle, Angela V. Turalba, Iryna A. Falkenstein, Michael Horsley, Julie H. Kim, Brian J. Song, Hana L. Takusagawa, Kaidi Wang, Teresa C. Chen
      Purpose To determine what percentage of normal eyes follow the ISNT rule, and whether ISNT rule variants may be more generalizable to the normal population. Design Cross-sectional study. Methods Setting : Institutional setting. Study Population : Total of 110 normal subjects. Observation Procedures : Neuroretinal rim assessments from disc photographs and retinal nerve fiber layer (RNFL) thickness measurements from spectral-domain optical coherence tomography. Main Outcome Measures : The percentages of subjects that obeyed the ISNT rule and its variants. Results The ISNT rule is only valid for 37.0% of disc photograph rim assessments and 43.8% of RNFL measurements. Deviation of the nasal sector from the expected ISNT pattern was a major cause for the ISNT rule not being obeyed for both rim and RNFL assessments. Specifically, 10.9% of subjects had wider nasal rims than the inferior rims, 29.4% had wider nasal rims than the superior rims, 14.7% had narrower nasal rims than the temporal rims, and 42.9% had thinner nasal RNFLs compared to the temporal quadrant. Exclusion of the nasal quadrant from the ISNT rule significantly increased the validity of ISNT variant rules, with 70.9% and 76.4% of disc photographs following the IST rule and the IS rule, respectively. Similarly, for RNFL thickness, 70.9% and 71.8% of patients followed the IST and IS rule, respectively. Conclusions The ISNT rule is only valid for about a third of disc photographs and less than half of RNFL measurements in normal patients. ISNT rule variants, such as the IST and IS rule, may be considered, as they are valid in more than 70% of patients.

      PubDate: 2017-10-18T02:21:47Z
  • West Indies Glaucoma Laser Study (WIGLS): 1. 12-Month Efficacy of
           Selective Laser Trabeculoplasty in Afro-Caribbeans With Glaucoma
    • Abstract: Publication date: December 2017
      Source:American Journal of Ophthalmology, Volume 184
      Author(s): Tony Realini, Hazel Shillingford-Ricketts, Darra Burt, Goundappa K. Balasubramani
      Purpose To characterize the 12-month intraocular pressure (IOP)-lowering efficacy of selective laser trabeculoplasty (SLT) as sole therapy for primary open-angle glaucoma (POAG) in an Afro-Caribbean population. Design Stepped-wedge trial. Methods Subjects in St. Lucia and Dominica with established POAG were randomized to prompt washout of IOP-lowering medications followed by SLT, 3-month delay followed by washout and SLT, or 6-month delay followed by washout and SLT. Baseline IOP was obtained on 2 different days after washout. Bilateral 360-degree SLT was performed in 1 session. Posttreatment assessments took place 1 hour, 1 week, and 3, 6, 9, and 12 months post-SLT. The main outcome measure was SLT success (defined as IOP ≤ target IOP in both eyes) at 12 months. Target IOP was a 20% or greater reduction in IOP from postwashout baseline. Results Overall, 72 patients underwent SLT treatment. Mean IOP at enrollment was 15.4 ± 3.6 mm Hg in right eyes and 15.4 ± 3.6 mm Hg in left eyes, which rose to 21.0 ± 3.3 mm Hg and 20.9 ± 3.0 mm Hg, respectively, after washout. Mean IOP at 3, 6, 9, and 12 months ranged from 12.5 mm Hg to 14.5 mm Hg (29.7% to 39.5%; P < .0001 in each eye at each time point). The 12-month success rate was 78%. Transient photophobia and discomfort were common. Conclusions SLT monotherapy safely provides significant IOP reduction in Afro-Caribbean eyes with POAG. This treatment can play a significant role in preventing glaucoma vision loss and blindness in people of African descent living in resource-limited regions.

      PubDate: 2017-10-18T02:21:47Z
  • Differences in Optical Coherence Tomography Assessment of Bruch Membrane
           Opening Compared to Stereoscopic Photography for Estimating Cup-to-Disc
    • Abstract: Publication date: December 2017
      Source:American Journal of Ophthalmology, Volume 184
      Author(s): Jean-Claude Mwanza, Linda Y. Huang, Donald L. Budenz, Wei Shi, Gintien Huang, Richard K. Lee
      Purpose To compare the vertical and horizontal cup-to-disc ratio (VCDR, HCDR) by an updated optical coherence tomography (OCT) Bruch membrane opening (BMO) algorithm and stereoscopic optic disc photograph readings by glaucoma specialists. Design Reliability analysis. Methods A total of 195 eyes (116 glaucoma and 79 glaucoma suspect) of 99 patients with stereoscopic photographs and OCT scans of the optic discs taken during the same visit were compared. Optic disc photographs were read by 2 masked glaucoma specialists for VCDR and HCDR estimation. Intraclass correlation coefficient (ICC) and Bland-Altman plots were used to assess the agreement between photograph reading and OCT in estimating CDR. Results OCT images computed significantly larger VCDR and HCDR than photograph reading before and after stratifying eyes based on disc size (P < .001). The difference in CDR estimates between the 2 methods was equal to or greater than 0.2 in 29% and 35% of the eyes for VCDR and HCDR, respectively, with a mean difference of 0.3 in each case. The ICCs between the readers and OCT ranged between 0.50 and 0.63. The size of disagreement in VCDR correlated weakly with cup area in eyes with medium (r2 = 0.10, P = .008) and large (r2 = 0.09, P = .007) discs. Conclusions OCT and photograph reading by clinicians agree poorly in CDR assessment. The difference in VCDR between the 2 methods was depended on cup area in medium and large discs. These differences should be considered when making conclusions regarding CDRs in clinical practice.

      PubDate: 2017-10-18T02:21:47Z
  • Elevated Aqueous Cytokine Levels in Eyes With Ocular Surface Diseases
    • Abstract: Publication date: December 2017
      Source:American Journal of Ophthalmology, Volume 184
      Author(s): Naohiko Aketa, Takefumi Yamaguchi, Teru Asato, Yukari Yagi-Yaguchi, Terumasa Suzuki, Kazunari Higa, Toshihide Kurihara, Yoshiyuki Satake, Kazuo Tsubota, Jun Shimazaki
      Purpose To evaluate cytokine and protein levels in the aqueous humor (AqH) of eyes with ocular surface diseases. Design Prospective consecutive case series. Methods This study includes 14 patients (aged 62.4 ± 13.7 years) with chronic-phase ocular surface diseases (4 with ocular cicatricial pemphigoid, 5 with chemical burns, 2 with a thermal burn, 2 with Stevens-Johnson syndrome, and 1 with exposure keratitis), 14 matched patients without ocular surface disease (controls with corneal scar), and 30 patients who underwent cataract surgery (healthy controls). AqH samples were collected at the beginning of surgery. AqH levels of cytokines (interleukin [IL]-1α, IL-1β, IL-4, IL-6, IL-8, IL-10, IL-12p70, IL-13, IL-17A, monocyte chemotactic protein [MCP]-1, interferon [IFN]-α, IFN-γ, macrophage inflammatory protein [MIP]-1α, MIP-1β, P-selectin, E-selectin, soluble-intercellular adhesion molecule [s-ICAM]-1, tumor necrosis factor [TNF]-α, granulocyte-macrophage colony-stimulating factor [GM-CSF], IFN-γ-induced protein [IP]-10) were measured using multiplex beads immunoassays. Results The levels of IL-6, IL-10, IL-17A, GM-CSF, E-selectin, P-selectin, and s-ICAM in AqH were significantly elevated in eyes with ocular surface diseases (in pg/mL: 1696 ± 804, 4.0 ± 1.0, 24.3 ± 9.8, 26.0 ± 18.3, 5150 ± 1232, 13122 ± 7219, and 7914 ± 2813, respectively), compared to healthy controls (IL-6: 6.36 ± 0.94, P = .001; IL-10: 1.68 ± 0.04, P = .0006; IL-17A: 3.7 ± 0.2, P = .008; GM-CSF: 2.7 ± 0.3, P = .007; E-selectin: 2093 ± 37, P = .0001; P-selectin: 3658 ± 137, P = .0001; sICAM-1: 1397 ± 119, P = .008). The levels of IL-6, IL-17A, E-selectin, and P-selectin in AqH were significantly higher in eyes with ocular surface diseases compared to those with corneal scar (IL-6: 44.1 ± 15.0, P = .0077; IL-17A: 4.1 ± 0.7, P = .034; E-selectin: 2439 ± 302, P = .039; and P-selectin: 5673 ± 1553, P = .017). Conclusions Multiple AqH cytokine levels were elevated in chronic ocular surface diseases.

      PubDate: 2017-10-18T02:21:47Z
  • Peripheral visual fields in ABCA4 Stargardt disease and correlation with
           disease extent on ultra-widefield fundus autofluorescence
    • Abstract: Publication date: Available online 14 October 2017
      Source:American Journal of Ophthalmology
      Author(s): Maria Fernanda Abalem, Benjamin Otte, Chris Andrew, Katherine A. Joltikov, Kari Branham, Abigail T. Fahim, Dana Schlegel, Cynthia X. Qian, John R. Heckenlively, Thiran Jayasundera
      Purpose To evaluate the disease extent on ultra-widefield fundus autofluorescence (UWF-FAF) in patients with ABCA4- Stargardt disease (STGD) and correlate this data with functional outcome measures. Design Retrospective cross sectional study Setting Kellogg Eye Center, University of Michigan Study population Sixty-five patients with clinical diagnosis and proven pathogenic variants in the ABCA4 gene. Observational procedures The UWF-FAF images were obtained using Optos 200- degrees and classified into three types. Functional testing included: kinetic widefield perimetry, full-field electroretinogram (ffERG) and visual acuity (VA). All results were evaluated with respect to UWF-FAF classification. Main outcome measures Classification of UWF-FAF; area comprising the I4e, III4e, and IV4e isopters; ffERG patterns; and VA. Results For UWF-FAF, 27 subjects (41.5%) were classified as type I; 17 (26.2 %) as type II; and 21 (32.4%) as type III. The area of each isopter correlated inversely with the extent of the disease and all isopters were able to detect differences among UWF-FAF types (IV4e, p = 0.0013; III4e, p = 0.0003; I4e, p < 0.0001= 3.93e-8). ffERG patterns and VA were also different among the three UWF-FAF types (p < 0.001= 6.61e-6 and p < 0.001= 7.3e-5, respectively). Conclusion Patients with widespread disease presented with more constriction of peripheral visual fields, had more dysfunction on ffERG and worse VA compared to patients with disease confined to the macula. UWF- FAF images may provide information for estimating peripheral and central visual function in STGD.

      PubDate: 2017-10-18T02:21:47Z
  • Macular fluid reduces reproducibility of choroidal thickness measurements
           on enhanced depth optical coherence tomography
    • Abstract: Publication date: Available online 14 October 2017
      Source:American Journal of Ophthalmology
      Author(s): Sophia S. Wong, Vivian S. Vuong, David Cunefare, Sina Farsiu, Ala Moshiri, Glenn Yiu
      Purpose To determine if different types of retinal fluid in the central macula affect the reproducibility of choroidal thickness (CT) measurements on enhanced depth imaging optical coherence tomography (EDI-OCT) Design retrospective, reliability analysis Methods EDI-OCT images were obtained and the choroidal-scleral junction was analyzed through semi-automated segmentation. CT was measured at the fovea and averaged across the central 3 mm horizontal segment. Demographic data, central macular thickness and type of fluid present were recorded. Intragrader and intergrader repeatability were assessed using the intraclass correlation coefficient (ICC) and coefficient of repeatability (CR). Results Of 124 eyes analyzed, 60 (48.4%) had diabetic macular edema, 32 (25.8%) had neovascular age-related macular degeneration, and 32 (25.8%) had other causes of fluid. Intergrader ICC (CR) were 0.95 (74.1 μm) and 0.96 (63.9 μm) for subfoveal and average CT, respectively. CR were similar across various causes of retinal fluid, but were worst for subretinal fluid compared to intraretinal or sub-retinal pigment epithelial fluid. CR also worsened with increasing choroidal thickness, but was not affected by retinal thickness. Intragrader repeatability was generally greater than intergrader values, and followed the same trend. Conclusions The presence of macular fluid reduces CT measurement reproducibility, particularly in eyes with subretinal fluid and greater choroidal thickness. A difference of 74.1 μm in subfoveal CT or 63.9 μm in average CT may be necessary to detect true clinical change in eyes with macular fluid.

      PubDate: 2017-10-18T02:21:47Z
  • Pregnancy-induced changes in corneal biomechanics and topography are
           thyroid hormone related
    • Abstract: Publication date: Available online 13 October 2017
      Source:American Journal of Ophthalmology
      Author(s): David Tabibian, Begoña M. de Tejada, Zisis Gatzioufas, Sabine Kling, Vanessa S. Meiss, Marc-Olivier Boldi, Véronique Othenin-Girard, Antonina Chilin, Julien Lambiel, Florence Hoogewoud, Farhad Hafezi
      Purpose To identify biomechanical and topographical changes of the cornea during pregnancy and the postpartum period and its association to hormonal changes. Design Prospective single-center observational cohort study. Methods Participants: 24 pregnant women (48 eyes), monitored throughout pregnancy and after delivery. Biomechanical and topographical corneal properties were measured using the Ocular Response Analyzer (ORA) and a Scheimpflug imaging system (Pentacam HR) each trimester and 1 month after delivery. At the same consultations blood plasma levels of estradiol (E2) and thyroid hormones (TSH, T3t, T4t) were also determined. A factorial MANOVA was used to detect interactions between hormonal plasma levels and ocular parameters. Results Significant differences in corneal biomechanical and topographical parameters were found during pregnancy in relation to T3t (p=0.01), T4t (p<0.001), T3t/T4t (p=0.001) and TSH (p=0.001) plasma levels. E2 plasma levels (p=0.092) and time-period of measurement (p=0.975) did not significantly affect corneal parameters. TSH levels significantly affected the maximal keratometry reading (p=0.036), the vertical keratometry (p=0.04) reading and the index of height asymmetry (p=0.014). Those results persist after excluding hypothyroidism patients from the statistical analysis. Conclusions Hormonal changes affecting corneal biomechanics and topography during pregnancy could be thyroid-related. Dysthyroidism may directly influence corneal biomechanics and represents a clinically relevant factor that needs further investigation. Highlights Thyroid hormones may affect corneal shape and biomechanical properties more than estrogen.

      PubDate: 2017-10-18T02:21:47Z
  • Long-term Outcomes of Ocular Surface Stem Cell Allograft Transplantation
    • Abstract: Publication date: Available online 13 October 2017
      Source:American Journal of Ophthalmology
      Author(s): Asadolah Movahedan, Albert Y. Cheung, Medi Eslani, Gautham Mogilishetty, Amit Govil, Edward J. Holland
      Purpose To investigate the long-term outcomes of ocular surface stem cell allograft transplantation (OSST) in patients with total limbal stem cell deficiency (LSCD) due to various etiologies with a follow-up ≥ 5 years. Design Retrospective interventional cohort. Methods ▪▪▪ Setting Single tertiary referral hospital. Study population Patients who had (1) presence of total LSCD, (2) surgical treatment with at least one allograft OSST procedure, and (3) minimum follow-up ≥ 5 years after OSST. Intervention All patients underwent allograft OSST from March 1998 to June 2009. All patients received systemic immunosuppression. Main outcome measures Ocular surface stability, best-corrected visual acuity (BCVA) Results 165 eyes of 110 patients fulfilled the inclusion criteria with a mean follow-up period of 109.22 ± 35.7 months or approximately 9.1 years (range 5.2 to 17.7 years). Ocular surface stability was achieved in 72.7% (120/165) of eyes at last follow-up, while 15.2% (25/165) maintained an improved ocular surface and 12.1% (20/165) developed total surface failure. Additional OSST surgery was necessary in 30.9% (51/165 eyes) to maintain a stable ocular surface. There was a ≥ 2 lines BCVA improvement in 62.1%, no change in 7.7%, and a worsened BCVA in 18.6% at last follow-up. Conclusions With proper immunosuppression and repeat procedure in case of failure, allograft OSST can provide true long-term ocular surface stability and successful visual outcomes.

      PubDate: 2017-10-18T02:21:47Z
  • Use of donors predisposed by corneal collagen cross-linking in penetrating
           keratoplasty for treating the patients with keratoconus
    • Abstract: Publication date: Available online 13 October 2017
      Source:American Journal of Ophthalmology
      Author(s): Ting Huang, Ruifen Ye, Chen Ouyang, Chao Hou, Yunwei Hu, Qianni Wu
      Purpose To investigate whether use of donors predisposed by corneal collagen cross-linking (CXL) reduced myopic refractive errors for keratoconic eyes after penetrating keratoplasty (PK). Design Randomized controlled trial. Methods One hundred sixteen eyes of 116 patients with keratoconus from Zhongshan Ophthalmic Center were enrolled. Using stratified block randomization, eligible eyes were assigned to CXL graft group (Group1) or conventional graft group (Group2). Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), spherical equivalent (SE), and topographic data were compared 12,24,and 36 months after surgery. Results Group1 had better UDVA and CDVA than Group2 after 1-year follow up. Also, Group1 had less degree of SE and lower manifest cylinder than Group2. At 3-years follow up, mean CDVA was 0.17±0.10 logarithm of the minimum angle of resolution (logMAR) in Group1 versus 0.23±0.12logMAR in Group2 (p=0.004). Mean SE was -3.50±2.93D in Group1; while -4.02±2.57D in Group2 (p=0.034). Mean manifest cylinder was -5.22±2.64D and -6.35±2.80D in Group1 and Group2, respectively (p=0.013). At 3-years follow up, simulated keratometry in the steepest meridian (Kmax) was 46.85 ± 2.85 D versus 49.37 ± 2.92 D (p=0.036); corneal power was 44.41± 2.89 D versus 46.35 ± 2.87 D (p=0.001); keratometric astigmatism was 4.53± 1.06 D versus 5.98 ± 1.28 D (p<0.001) in Group1 and Group2, respectively. Conclusions Use of donors predisposed by CXL could reduce topographic readings after PK for the treatment of keratoconus, consequently reduce myopic refractive errors and improved visual acuity.

      PubDate: 2017-10-18T02:21:47Z
  • Early response to intravitreal dexamethasone implant therapy in diabetic
           macular edema may predict visual outcome
    • Abstract: Publication date: Available online 13 October 2017
      Source:American Journal of Ophthalmology
      Author(s): Hasenin Al-khersan, Seenu M. Hariprasad, Jay Chhablani
      Purpose To determine whether early visual acuity response to intravitreal dexamethasone implant therapy in diabetic macular edema (DME) is associated with long-term outcome. Design Retrospective case series Methods Multicenter (eight sites) retrospective review of medical records of eyes with DME treated with 0.7mg intravitreal dexamethasone implant and minimum eighteen-month follow-up. One hundred and two eyes were included. Eyes with vitroretinal interface abnormalities or that had undergone vitrectomy were excluded. Eyes were categorized into three groups based on change in best-corrected visual acuity (BCVA) at three months (logMAR equivalence of <5-letter, 5-9-letter, or ≥10-letter gain). Visual acuity outcomes were determined for each early response group. The relationship between early (three month) and overall change in BCVA was assessed using regression analysis. Results In the study population (102 eyes), <5-, 5-9-, and ≥10-letter BCVA improvements were seen in 44.1%, 18.6%, and 37.3% of eyes, respectively, at three months. Among suboptimal (<5-letter) responders at three months, 6.7% showed ≥10-letter gains at study conclusion compared to 29% in the robust (≥10-letter) early response group (p=0.009). Change in BCVA at three months showed significant positive correlation with overall change in BCVA (coefficient=0.44, p=0.002). Conclusions A similar proportion of eyes demonstrated suboptimal (<5-letter) and robust (≥10-letter) early response to treatment at three months. Eyes with a robust early response demonstrated ≥10-letter long-term gain in BCVA at a significantly higher rate compared to those with poor early response. Early treatment response directly correlated with overall change in BCVA.

      PubDate: 2017-10-18T02:21:47Z
  • Physician Assistants and Nurse Practitioners in Ophthalmology—Has
           the Time Come'
    • Authors: David Browning
      Abstract: Publication date: Available online 9 October 2017
      Source:American Journal of Ophthalmology
      Author(s): David J. Browning

      PubDate: 2017-10-10T14:05:22Z
  • Diabetic Choroidopathy: Choroidal Vascular Density and Volume in Diabetic
           Retinopathy with Swept-Source Optical Coherence Tomography
    • Authors: Jay Wang; Joana Grayson Armstrong Ana Santos Pedro Gil Gil
      Abstract: Publication date: Available online 6 October 2017
      Source:American Journal of Ophthalmology
      Author(s): Jay C. Wang, Inês Laíns, Joana Providência, Grayson W. Armstrong, Ana R. Santos, Pedro Gil, João Gil, Katherine E. Talcott, João H. Marques, João Figueira, Demetrios G. Vavvas, Ivana K. Kim, Joan W. Miller, Deeba Husain, Rufino Silva, John B. Miller
      Purpose To compare choroidal vascular density (CVD) and volume (CVV) in diabetic eyes and controls, using en face swept-source optical coherence tomography (SS-OCT). Design Prospective cross-sectional study. Methods ▪▪▪ Setting Multicenter Patient Population 143 diabetic eyes – 27 with no diabetic retinopathy (DR), 47 with nonproliferative DR (NPDR), 51 with NPDR and diabetic macular edema (DME), and 18 with proliferative DR (PDR), and 64 age-matched non-diabetic control eyes. Observation procedures Complete ophthalmologic examination and SS-OCT imaging. En face SS-OCT images of the choroidal vasculature were binarized. Main outcome measures CVD, calculated as the percent area occupied by choroidal vessels in the central macular region (6-mm diameter circle centered on the fovea), and throughout the posterior pole (12 x 9 mm). The central macular CVV was calculated by multiplying the average CVD by macular area and choroidal thickness (obtained with SS-OCT automated software). Multilevel mixed linear models were performed for analyses. Results Compared to controls (0.31 ± 0.07), central macular CVD was significantly decreased by 9% in eyes with NPDR + DME (0.28 ± 0.06; ß=-0.03, p=0.02) and by 15% in PDR (0.26 ± 0.05; ß= -0.04, p=0.01). The central macular CVV was significantly decreased by 19% in eyes with PDR (0.020 mm3 ± 0.005 mm3, ß = -0.01, p=0.01) compared to controls (0.025 mm3 ± 0.01 mm3). Conclusions Choroidal vascular density and volume are significantly reduced in more advanced stages of diabetic retinopathy. New imaging modalities should allow further exploration of the contributions of choroidal vessel disease to diabetic eye disease pathogenesis, prognosis, and treatment response.

      PubDate: 2017-10-10T14:05:22Z
  • Outcomes and Prognostic Factors of Cataract Surgery in Adult Extreme
           Microphthalmos with Axial Length <18 mm or Corneal Diameter <8 mm
    • Authors: Tianyu Zheng; Zhanghua Chen Jie Yating Tang Fan
      Abstract: Publication date: Available online 6 October 2017
      Source:American Journal of Ophthalmology
      Author(s): Tianyu Zheng, Zhanghua Chen, Jie Xu, Yating Tang, Qi Fan, Yi Lu
      Purpose To study the long-term visual outcomes, complications and prognostic factors for cataract surgery in extreme microphthalmos. Design Prospective cohort study. Methods Thirty eyes with simple microphthalmos [11 eyes, axial length (AL) <18 mm], complex microphthalmos [8 eyes, AL <18 mm] and relative anterior microphthalmos [RAM, 11 eyes, corneal diameter (CD) <8 mm] who underwent cataract surgery (phacoemulsification) in our hospital were followed for a mean of 25.3 months with at least three visits at early (1 day-1 week), mid (1-3 months) and late (>6 months) stages after surgery. The main outcome measures included the best-corrected visual acuity (BCVA), intraocular pressure (IOP) and complications. Results Significant improvements of BCVA were observed at the mid- and late postoperative visits in the entire cohort when compared with preoperative value (p<0.05). When divided into three groups, a statistically significant improvement in late-stage BCVA was observed in the simple microphthalmos and RAM groups. The AL, preoperative ACD and preoperative BCVA were significant prognostic factors for late-stage BCVA after surgery. The most common complications were early corneal edema (73%), glaucoma (33%) and posterior capsular opacification (23%). Preoperative ACD was significantly associated with the incidence of glaucoma after surgery (p<0.05). Severe complications included suprachoroidal hemorrhage (3%), endothelial dysfunction (7%) and retinal detachment (7%). Conclusions Cataract surgery provided visual improvement in extreme microphthalmos (simple microphthalmos and RAM), with higher risks of complications than with routine cataract surgeries. Extreme microphthalmos with preoperative characteristics of relatively longer AL, deeper ACD and better BCVA may benefit more from cataract surgery.

      PubDate: 2017-10-10T14:05:22Z
  • Choroidal Thinning Associated with Hydroxychloroquine Retinopathy
    • Authors: Seong Joon Ahn; So Jung Ryu; Joo Young Joung; Byung Ro Lee
      Abstract: Publication date: Available online 8 September 2017
      Source:American Journal of Ophthalmology
      Author(s): Seong Joon Ahn, So Jung Ryu, Joo Young Joung, Byung Ro Lee
      Purpose To investigate choroidal thickness in patients using hydroxychloroquine (HCQ) and compare choroidal thickness between eyes with and without HCQ retinopathy. Design Retrospective case series Methods Setting: Institutional Patients: We included 124 patients with systemic lupus erythematosus or rheumatoid arthritis who were treated with HCQ. The patients were divided into an HCQ retinopathy group and a control group, according to the presence or absence of HCQ retinopathy. Observation: Total choroidal thickness and choriocapillaris-equivalent thickness were measured manually by two independent investigators using swept-source optical coherence tomography (SS-OCT; DRI-OCT, Topcon Inc., Tokyo, Japan). These measurements were made at the fovea and at nasal and temporal locations 0.5, 1.5, and 3 mm from the fovea. Medium-to-large vessel layer thickness was calculated accordingly. The thicknesses were compared between the HCQ retinopathy and control groups. We performed correlation analyses between choroidal thicknesses and details regarding HCQ use. Main outcome measures: Total choroidal thickness and choriocapillaris-equivalent thickness Results Choroidal thicknesses were significantly decreased (P<.05) in the HCQ retinopathy group compared to the control group except at the temporal choroid 1.5 mm from the fovea. Choriocapillaris-equivalent thicknesses were significantly different in all choroidal locations between the groups. In contrast, the medium-to-large vessel layer thickness was only significantly different at a few locations. The cumulative dose/body weight was significantly correlated with subfoveal choroidal and choriocapillaris-equivalent thicknesses (both P=.001). The association between presence of HCQ retinopathy and choroidal thicknesses was also statistically significant after adjusting for age, diagnosis for HCQ use, refractive errors, and duration of HCQ use (P=.001 and .003 for subfoveal choroidal and choriocapillaris-equivalent thickness, respectively). Conclusions These results all suggest that HCQ retinopathy is associated with choroidal thinning, especially in the choriocapillaris. Our results may suggest choroidal involvement of HCQ toxicity.

      PubDate: 2017-09-14T02:13:10Z
      DOI: 10.1016/j.ajo.2017.08.022
  • Analysis of Cytokine levels in tears and Clinical Correlations after
           Intense Pulsed Light Treating Meibomian Gland Dysfunction
    • Authors: Ruixing Liu; Bei Rong; Ping Tu; Yun Tang; Wenjing Song; Toyos Rolando; Toyos Melissa; Xiaoming Yan
      Abstract: Publication date: Available online 6 September 2017
      Source:American Journal of Ophthalmology
      Author(s): Ruixing Liu, Bei Rong, Ping Tu, Yun Tang, Wenjing Song, Toyos Rolando, Toyos Melissa, Xiaoming Yan
      Purpose To investigate the change from baseline of inflammatory markers in tears of dry eye disease(DED) subjects due to meibomian gland dysfunction(MGD) after IPL(intense pulsed light) treatment and meibomian gland expression(MGE) compared to sham treatment, and the correlations with ocular surface parameters. Design Randomized, double-masked, controlled study. Methods Those randomized into the active treatment arm received 3 consecutive treatments(14∼16J/cm2) approximately 4 weeks apart in the periocular region. Control eyes received 3 treatments in the same intervals of 0J/cm2. Tear samples in all eyes were collected and analyzed at baseline, Week 12 and/or Week 4 for interleukin(IL)-17A, interleukin(IL)-6, and prostaglandin E2(PGE2).The correlations between cytokines and ocular surface parameters were analyzed before and after IPL treatment. Results All of the inflammatory markers declined in value compared to baselines. IL-17A and IL-6 showed statistically significant decreases compared to sham treatment at each measured time point. PGE2 showed statistically significant decreases compared to sham at Week 12. Results showed that the expressions of IL-17A and IL-6 correlated well with ocular surface parameters of the lower eyelid before IPL. The changed values of IL-6 and PGE2 in tears correlated with the changed values of partial ocular surface parameters after IPL treatment in study eyes, respectively. Conclusions The study results suggest IPL can significantly reduce inflammatory markers in tears of patients suffering with DED due to MGD after IPL treatment. These findings indicates that IL-17A and IL-6 play roles in the pathogenesis of DED due to MGD, and the reduction of the inflammatory factors is consistent with the improvement of partial clinical symptoms and signs.

      PubDate: 2017-09-08T01:52:00Z
      DOI: 10.1016/j.ajo.2017.08.021
  • Preparing a Systematic Review for the American Journal of Ophthalmology:
           Updated Guidance
    • Authors: Gianni Virgili; Richard K. Parrish
      Abstract: Publication date: Available online 6 September 2017
      Source:American Journal of Ophthalmology
      Author(s): Gianni Virgili, Richard K. Parrish

      PubDate: 2017-09-08T01:52:00Z
      DOI: 10.1016/j.ajo.2017.08.014
  • Primary (Month-6) Outcomes of the STOP-Uveitis Study: Evaluating the
           Safety, Tolerability, and Efficacy of Tocilizumab in Patients with
           Non-Infectious Uveitis
    • Authors: Yasir Jamal Sepah; Mohammad Ali Sadiq; David S. Chu; Mark Dacey; Ron Gallemore; Pouya Dayani; Mostafa Hanout; Muhammad Hassan; Rubbia Afridi; Aniruddha Agarwal; Muhammad Sohail Halim; Diana V. Do; Quan Dong Nguyen
      Abstract: Publication date: Available online 5 September 2017
      Source:American Journal of Ophthalmology
      Author(s): Yasir Jamal Sepah, Mohammad Ali Sadiq, David S. Chu, Mark Dacey, Ron Gallemore, Pouya Dayani, Mostafa Hanout, Muhammad Hassan, Rubbia Afridi, Aniruddha Agarwal, Muhammad Sohail Halim, Diana V. Do, Quan Dong Nguyen
      Purpose To report the primary end-point analyses of the safety and efficacy of two different doses of intravenous (IV) infusions of tocilizumab (TCZ), an IL-6 inhibitor, in eyes with non-infectious intermediate, posterior or pan-uveitis. Design Randomized, controlled, multicenter clinical trial. Methods STOP-Uveitis is a randomized, open-label safety, efficacy and bioactivity clinical trial conducted at 5 clinical centers across the United States. The study evaluated the role of TCZ in patients with non-infectious uveitis (NIU). 37 Patients with NIU were randomized into one of 2 treatment groups in a ratio of 1:1. Group 1 received intravenous (IV) infusions of 4mg/kg TCZ and group 2 received IV infusions of 8mg/kg TCZ. Infusions were given every 4 weeks in both groups until month 6 (primary endpoint). Primary outcome measure was incidence and severity of systemic and ocular adverse events through month 6. Secondary outcome measures included mean change in visual acuity (VA), vitreous haze (VH) and central macular thickness (CMT) at month 6. Results A total of 37 patients were randomized in the study. At month 6, 43.5% of patients who had the potential for a 2-step decrease in VH, demonstrated a 2-step decrease (40% in group 1 and 46.1% in group 2). Mean change in CMT was -83.88 ± 136.1μm at month 6 (-131.5 ± 41.56μm in group 1 and -38.92 ± 13.7μm in group 2). Mean change in VA was +8.22 ± 11.83 ETDRS letters at month 6 (10.9 ± 14.6 in group 1 and 5.5 ± 7.8 in group 2). Repeated infusions of TCZ were well tolerated. Conclusions Repeated IV administrations of TCZ are well tolerated. TCZ (both 4 and 8 mg/kg) is effective in improving VA and reducing VH and CMT in eyes with non-infectious intermediate, posterior and pan-uveitis.

      PubDate: 2017-09-08T01:52:00Z
      DOI: 10.1016/j.ajo.2017.08.019
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